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As California coronavirus cases spike, contact tracing stalled by fear and embarrassment

Factors such as testing delays, distrust and embarrassment are combining to make efforts to contain COVID-19 more difficult in the state that now has the highest number of cases in the nation.
Illustration of man on cellphone looking off to the side of the frame as surgical masks blow in the wind around him.
Anuj Shrestha / for NBC News

Every day, Solange Madriz spends several emotionally draining hours on the phone with people who are scared.

The people on the other end of the line have all been identified as close contacts of an individual who tested positive for COVID-19, and she is one of 180 contact tracers in San Francisco calling to tell them to get tested and stay home.

“You could tell by the tone of the voice, by the way they’re asking questions, and it's heartbreaking,” Madriz said. “I have social services that can support them and it's just heartbreaking to know they are experiencing fear — not only are they sick, but they are experiencing fear in a moment when they need a hand to support them.”

If they have to take time off to quarantine, they worry about losing a paycheck and then missing rent, she said. Immigrants worry their information could be shared with the federal authorities, and whether accessing public assistance could be held against them in future immigration proceedings, according to Madriz, who said most of her calls are done in Spanish.

But even just getting people on the phone can be a challenge, thanks to a confluence of factors hampering California’s contact tracing efforts — all of which ultimately make it more difficult to control the spread of COVID-19 in a state that now has the highest number of cases in the country.

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A distrust of the government has caused a portion of people who contract COVID-19 to refuse to share information on whom they’ve been in close contact with before they tested positive, while others have declined out of sheer embarrassment. Delays getting the results of tests rendered contact tracing efforts moot in some cases. Meanwhile, the rise in cases in the state have challenged contact tracers to keep up with the sheer volume of people to call.

“It’s not a good situation,” said Brad Pollock, associate dean for public health sciences at the University of California Davis School of Medicine. “It might’ve been an OK situation three and a half or four weeks ago thinking the epidemic leveled off, but the epidemic didn’t stay still.”

California became the fourth state to pass 100,000 total confirmed cases of the coronavirus May 27, right after the state began letting counties reopen certain businesses. It has since jumped to over 481,000 cases, tracking by NBC News shows, leading the nation. Los Angeles County alone has 183,383 confirmed cases, health officials said Wednesday.

Public health experts say contact tracing is going to be critical to containing the spread and getting states to a point where they can reopen.

“There is no place in the world that has successfully limited transmission without a contact tracing program,” said Emily Gurley, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, and lead instructor for an online course on contact tracing.

In late May, Gov. Gavin Newsom announced the state would train 10,000 people to become contact tracers in programs run at the county level, an effort called California Connected. But as the number of confirmed coronavirus cases in California, and in several other states, have grown over the summer, so too have the delays in getting testing results back.

Daniel Parker, an assistant professor of public health at the University of California Irvine, who is training tracers in Orange County, said they really need to get in touch with someone’s contact within three days of a positive test result to intercept transmission of the disease. But if it takes a week or more to get the results, “you have to question whether it’s worthwhile at that point,” he said.

In Los Angeles County, which aims to reach 4,000 people a day in its contact tracing program, officials recently started offering $20 gift cards to people who participate. Officials announced the new incentive after calculating that nearly half of the people who tested positive would not share their close contacts.

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“This is because people — and people have told us — that they’re fearful of losing their housing, their jobs and their relationships,” Los Angeles County Public Health Director Barbara Ferrer said in a press briefing last week.

True Beck, a public health worker managing a contact tracing team in Los Angeles, said in a few cases people have claimed on the phone that they haven’t been in contact with anyone, even though county employees can hear people in the background.

Controlling the spread of the disease is especially critical for people of color who have been disproportionately dying of COVID-19. Los Angeles is trying to address the disparity by opening more testing sites in Black and Latino communities this month.

But Dr. Stephen Lockhart, chief medical officer for Sutter Health, a nonprofit health company operating hospitals and clinics in Northern California, said long-standing racial discrimination has given many people in Black communities reason to be skeptical of government agencies. In order for testing and tracing operations to be successful, he said, counties need to partner with groups that are trusted in these communities.

“It is a reflection, I think, of the lived experience of many in the Black community,” he said. “It can be overcome, but it must be addressed.”

Other counties outside of Los Angeles have also seen resistance. In San Bernardino County, only about 25 percent of cases investigated shared who their close contacts were, a spokesperson said. Merced County had so much difficulty gathering information that it simply stopped doing contact tracing altogether, CalMatters reported.

Michael Osur, Riverside County’s assistant director for public health, said his team has encountered people who feared speaking with a contact tracer could get them fired.

“We do have certain businesses that tell their people not to cooperate with us, and there tend to be more people of color working in those industries,” he said, referring to food processing workers and farmworkers.

Contact tracing efforts in California have also been hampered by reports of scammers posing as tracers and trying to get a person’s money or the Social Security number, as well as the national scourge of robocalls making people less likely to answer phones for unknown numbers.

Officials in Stanislaus County, in California’s Central Valley, said in a new conference last week that they realized their public health phone number does not have a caller ID, something they’re trying to fix.

Ultimately, health experts say, what they need more than anything to make contact tracing more fruitful is the public’s cooperation with social distancing measures and wearing face coverings.

“We need people to wear masks. Over and out,” said George Rutherford, an epidemiologist at the University of California San Francisco, who designed a contact tracing training program.

“Along with staying out of bars, that will drop the case rates. The fewer the cases, the easier this becomes.”